Commentary in Pediatrics: Redefining the Science and Policy of Early Childhood Intervention Programs

If you have not yet gotten caught up in the debate between the merit of selected versus universal home visiting for newborns and parents or other caretakers, you are likely to in the near future. While one cannot argue with the need to provide services as early as possible to negate the adverse childhood experiences that may confront infants at birth, universal home visits may deplete resources that could be better channeled to those who really need them. But, what impacts do home nursing visits make in long run? To answer that question, Olds et al (10.1542/peds.2018-3889) share with us a revisit to their Nurse-Family Partnership program that involved randomly assigning 742 low-income pregnant women who had not previously given birth and their offspring to prenatal and infant home visiting plus transportation for prenatal visits and comprehensive developmental screening. These mother-infant dyads were compared to a control group that of mothers and infants who got the transportation and screening but no home visits. The authors share results of this study in two successive articles for the infants at 18 years of age—one focused on the cognitive and behavioral outcomes of the children now as teenagers, and the second (10.1542/peds.2018-3876) focused on their mothers and their use of public specific benefits such as the Supplemental Nutrition Assistance Program (SNAP), Aid to Families with Dependent Children (AFDC), and Medicaid. The results may surprise you. At first glance the program appears to not have impacted most of the relevant outcomes. But if you look at specific subsets of the overall group, important findings light up. For example, youth in the intervention group born to mothers with limited psychological resources for their mental health and wellbeing showed significant improvement in their language and math skills compared to controls. Likewise, women with higher psychological wellbeing at the time of enrollment had fewer subsequent births and lower governmental expenditures when their firstborns were 18.

Does this mean home nursing visits are not cost-effective for most families? To further interpret these two studies, we asked Dr. Kenneth Dodge, from the Center for Child and Family Policy at Duke to share his thoughts in an accompanying commentary (10.1542/peds.2019-2606). Dr. Dodge reminds us that the goal of a study like the Nurse-Family Partnership is not to simply determine if it works or not, but instead to also determine for whom the program is most beneficial. Dr. Dodge calls for a universal home screen to triage families for home. There is a lot of important information contained in both studies and in the commentary that may help you reset your perspective on what “universal” home visiting should and should not be about. Read both articles and commentary and see for yourself.

Article 1, Behavioral Outcomes: Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial

Article 2, Public Benefits Usage: Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial

Commentary: Redefining the Science and Policy of Early Childhood Intervention Programs